Total intravenous anesthesia versus inhalational anesthesia in patients undergoing laparoscopic cholecystectomy. A comparative study of postoperative subclinical hepatic dysfunction

Inhalational anesthetics are reported to cause mild liver dysfunction in some cases. This dysfunction reflected as asymptomatic transient elevation in liver enzyme. On the other hand no reports have indicated that total intravenous anesthetics [TIVA] cause liver or other organ dysfunction. In addition the use of TIVA become popular due to the availability of new drugs which have short acting effects and TIVA technique produce less air pollution. 40 patients undergoing laparoscopic cholecystectomy were randomized into two equal groups. The first group received inhalational anesthesia. Anesthesia induced with fentanyl 2 microg/kg, atracurium 0.5 mg/kg, propofol 2.5mg/kg and was maintained using sevoflurane 2-3%, nitrous oxide 66% in oxygen with atracurium infusion at rate of 0.5 mg/kg/hr. The second group received TIVA. Anesthesia was induced with fentanyl 2 microg /kg and atracurium 0.5 mg/kg and propofol 2.5 mg/kg. and anesthesia was maintained using propofol infusion using a syringe pump at a rate of 10 mg/kg/hr for 10 mm then 8 mg/kg for the next 10 mm and finally maintained at 6mg/kg/hr with nitrous oxide 66% in oxygen and muscle relaxation was maintained with infusion of atracurium in rate of 0.5 mg/kg/h. Liver enzymes were measured preoperative, at the end of operation, 3h, 6h, and 24 hours postoperative and compared to the preoperative values. There were transient significant increase in the values of AD, GST, and AST in inhalational group and ALT significantly increased in both groups. There were insignificant changes in hemodynamic parameters. TIVA technique is superior to inhalational technique during laparoscopic cholecystectomy as regards its effect on the liver enzymes

Nasal ketamine versus nasal midazolam for pediatric premedication

Ninety patients A.S.A.I and 11 their age ranging from one to six years were undergoing general and urological surgeries. The patients were divided randomly into three groups, each of thirty patients. Group A, Group B and Group C. Group A received nasal ketamine in a dose of 5 mg/kg, Group B received nasal midazolam in a dose of 0.15 mg/kg [Control group] received IM midazolam in a dose of 0.1 mg/kg and Mepridine 1 mg/kg IM. Sedation was started as excellent in 19 children and as adequate in 6 children in the ketamine group [Group A] compared with 16 and 7 children in midazolam [Group B]. In Group C [control group], sedation was started as excellent in 9 children and adequate in 7 children